Traditional Bone Setting Leading to Compartment Syndrome of Arm: A Case Report

The traditional practice of bone setting is more prevalent in developing countries, including India. These traditional practices of fracture management lead to numerous limb-threatening complications like non-union, pressure necrosis, gas gangrene, nerve palsies, necrotizing fasciitis, and most importantly, compartment syndrome. Approximately 75% of acute compartment syndrome (ACS) occurs due to an underlying long bone fracture, most commonly fractures of the tibia, followed by forearm fractures. We report a case of rare occurrence of compartment syndrome of the arm, highlighting the challenges in its management, and also raise awareness about traditional bone setting and its complications.

A 35-year-old male patient with a right distal one-third humerus shaft fracture and a non-displaced radial neck fracture, treated by a traditional bone setter, presented with complaints of swelling and pain in the arm, 4 days after the injury. On clinical and radiological evaluation, the patient was diagnosed with compartment syndrome of arm resulting in right radial nerve palsy and pressure necrosis of superficial muscles with skin blisters. Peripheral pulses were feeble. Debridement with external fixation and radial nerve exploration was performed. Split skin grafting was done for wound coverage. Sarmiento functional cast was applied once the wounds healed. Patient had a satisfactory functional outcome at 1 year follow-up.

This case highlights the potentially devastating consequences of traditional bone-setting practices, which remain prevalent in developing countries. The occurrence of ACS with subsequent radial nerve palsy following non-operative manipulation of humerus fracture underscores the urgent need for early recognition, prompt referral, and appropriate orthopedic intervention. Reporting this case is important as it not only contributes to the limited literature on upper limb compartment syndrome secondary to traditional fracture treatment but also serves to raise awareness among healthcare providers, policymakers, and the community about the risks associated with unscientific fracture management practices.